General Surgery I, University of Siena, Siena, Italy.
Colorectal Dis. 2011 Oct;13(10):1167-72. doi: 10.1111/j.1463-1318.2010.02427.x.
Dynamic evacuation proctography (DEP) is still considered the gold standard diagnostic procedure for posterior compartment pelvic disorders. The study aimed to assess the value of dynamic transperineal ultrasound (DTPU) compared with DEP in patients with obstructed defaecation syndrome (ODS).
In a prospective observational study, 54 consecutive female patients referred with symptoms of ODS between January and June 2009 were studied by clinical evaluation (including Wexner score), perineal ultrasound and defaecography. The tests were analysed by two experienced investigators unaware of the opinion of the other.
DEP revealed a rectocoele in 35 (64%), intussusception in 27 (50%) and enterocoele in 10 (18.5%) patients. DTPU revealed a rectocoele in 32 (59%), intussusception in 23 (42%) and enterocoele in 11 (20%) patients. The degree of agreement of the two techniques calculated using the Cohen kappa method was 0.69 for rectocoele, 0.74 for intussusception and 0.86 for enterocoele. In patients with grade 2-3 rectocoele, the agreement was 0.88. There was no significant difference between the two techniques in the measurement of the anorectal angle or in the detection of dyssynergic contraction of the puborectalis. DTPU was better at identifying multiple diagnoses and associated pelvic floor alterations.
The degree of concordance between the two techniques is good. DTPU is accurate for asymptomatic patients with ODS and can be considered an alternative to DEP in the assessment of such patients.
动态排粪造影（DEP）仍然被认为是诊断后盆腔疾病的金标准诊断程序。本研究旨在评估动态经会阴超声（DTPU）与 DEP 在阻塞性排便障碍综合征（ODS）患者中的比较价值。
在 2009 年 1 月至 6 月期间，对 54 例因 ODS 症状而就诊的连续女性患者进行了前瞻性观察研究，评估包括临床评估（包括 Wexner 评分）、会阴超声和排粪造影。由两名具有丰富经验的研究人员进行分析，且彼此之间不了解对方的意见。
DEP 显示 35 例（64%）直肠前突、27 例（50%）内套叠和 10 例（18.5%）肠膨出。DTPU 显示 32 例（59%）直肠前突、23 例（42%）内套叠和 11 例（20%）肠膨出。使用 Cohen kappa 方法计算的两种技术的一致性程度为直肠前突 0.69、内套叠 0.74 和肠膨出 0.86。在 2-3 级直肠前突患者中，一致性为 0.88。两种技术在测量肛直角或检测耻骨直肠肌协同收缩方面没有显著差异。DTPU 更能识别多种诊断并发现相关盆底改变。
两种技术之间的一致性程度较好。DTPU 对无症状 ODS 患者准确，可作为此类患者评估的 DEP 的替代方法。
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